PREVALENCE OF DEPRESSIVE SYMPTOMS AND THE EFFECTIVENESS OF ANTIDEPRESSANTS IN ROUTINE CLINICAL PRACTICE OF SCHIZOPHRENIA (original) (raw)
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Gray Matter Volume Decreases in Elderly Patients with Schizophrenia: A Voxel-based Morphometry Study
Schizophrenia bulletin, 2011
Background: Aged patients (>50 years old) with residual schizophrenic symptoms differ from young patients. They represent a subpopulation with a more unfavorable Kraepelinian course and have an increased risk (up to 30%) for dementia of unknown origin. However, our current understanding of age-related brain changes in schizophrenia is derived from studies that included less than 17% of patients who were older than 50 years of age. This study investigated the anatomical distribution of gray matter (GM) brain deficits in aged patients with ongoing schizophrenia. Methods: Voxel-based morphometry was applied to 3D-T1 magnetic resonance images obtained from 27 aged patients with schizophrenia (mean age of 60 years) and 40 age-matched normal controls. Results: Older patients with schizophrenia showed a bilateral reduction of GM volume in the thalamus, the prefrontal cortex, and in a large posterior region centered on the occipito-temporo-parietal junction. Only the latter region showed...
Cortical Thickness Abnormalities at Different Stages of the Illness Course in Schizophrenia
JAMA Psychiatry
IMPORTANCE Questions of whether and how cortical thickness (CTh) alterations differ over the course of schizophrenia (SCZ) have yet to be resolved. OBJECTIVE To characterize CTh alterations across illness stages in SCZ. DATA SOURCES PubMed, Embase, Web of Science, and Science Direct were screened for CTh studies published before June 15, 2021. STUDY SELECTION Original studies comparing whole-brain CTh alterations from healthy controls in individuals at clinical high-risk (CHR), first episode of psychosis (FEP), and long-term illness stages of SCZ were included. DATA EXTRACTION AND SYNTHESIS This preregistered systematic review and meta-analysis followed PRISMA reporting guidelines. Separate and pooled meta-analyses were performed using seed-based d mapping. Meta-regression analyses were conducted. MAIN OUTCOMES AND MEASURES Cortical thickness differences from healthy control individuals across illness stages. RESULTS Ten studies comprising 859 individuals with CHR (mean [SD] age, 21.02 [2.66] years; male, 573 [66.7%]), 12 studies including 671 individuals with FEP (mean [SD] age, 22.87 [3.99] years; male, 439 [65.4%]), and 10 studies comprising 579 individuals with long-term SCZ (mean [SD] age, 41.58 [6.95] years; male, 396 [68.4%]) were included. Compared with healthy control individuals, individuals with CHR showed cortical thinning in bilateral medial prefrontal cortex (z = −1.01; P < .001). Individuals with FEP showed cortical thinning in right lateral superior temporal cortex (z = −1.34; P < .001), right anterior cingulate cortex (z = −1.44; P < .001), and right insula (z = −1.14; P = .002). Individuals with long-term SCZ demonstrated CTh reductions in right insula (z = −3.25; P < .001), right inferior frontal cortex (z = −2.19; P < .001), and left (z = −2.37; P < .001) and right (z = −1.94; P = .002) temporal pole. There were no significant CTh differences between CHR and FEP. Individuals with long-term SCZ showed greater cortical thinning in right insula (z = −2.58; P < .001), right inferior frontal cortex (z = −2.32; P < .001), left lateral temporal cortex (z = −1.91; P = .002), and right temporal pole (z = −1.82; P = .002) than individuals with FEP. Combining all studies on SCZ, accelerated age-related CTh reductions were found in bilateral lateral middle temporal cortex and right pars orbitalis in inferior frontal cortex. CONCLUSIONS AND RELEVANCE The absence of significant differences between FEP and CHR noted in this systematic review and meta-analysis suggests that the onset of psychosis was not associated with robust CTh reduction. The greater cortical thinning in long-term SCZ compared with FEP with accelerated age-related reduction in CTh suggests progressive neuroanatomic alterations following illness onset. Caution in interpretation is needed because heterogeneity in samples and antipsychotic treatment may confound these results.
2013
The aim of the present study was to investigate the influence of age on cerebral cortical thickness in adolescents with early-onset schizophrenia (EOS) (n ¼22, aged 12-18 years), as compared to an agematched healthy control group (n ¼32). All participants were scanned with magnetic resonance imaging. Whereas in the healthy control group there was a negative association between increasing age and cortical thickness measures in widespread brain regions, including frontal and parietal cortices, the patient group showed no significant effects of age when the groups were studied separately. There was a trend towards an age-by-group effect in the left supramarginal gyrus and the right pre-and postcentral gyri. The between-group statistical analysis indicated similar cortical thickness in the patients as in the healthy controls. There were no significant effects of medication on cortical thickness, nor was there any significant sex-by-group interaction. The results suggest that patients with EOS have a deficiency of the expected cortical thinning to occur during adolescence development. The findings are discussed in context of neurobiological processes known to be involved in brain maturation, including synaptic reorganization, pruning and myelination.
Schizophrenia Research, 2008
Morphological abnormalities of the cerebral cortex have been reported in a number of MRI-studies in schizophrenia. Uncertainty remains regarding cause, mechanism and progression of the alterations. It has been suggested that antipsychotic medication reduces total gray matter volumes, but results are inconsistent. In the present study differences in regional cortical thickness between 96 patients with a DSM-IV diagnosis of schizophrenia (n = 81) or schizoaffective disorder (n = 15) and 107 healthy subjects (mean age 42 years, range 17-57 years) were investigated using MRI and computer image analysis. Cortical thickness was estimated as the shortest distance between the gray/white matter border and the pial surface at numerous points across the entire cortical mantle. The influence of age and antipsychotic medication on variation in global and regional cortical thickness was explored. Thinner cortex among patients than controls was found in prefrontal and temporal regions of both hemispheres, while parietal and occipital regions were relatively spared. Some hemispheric specificity was noted, as regions of the prefrontal cortex were more affected in the right hemisphere, and regions of the temporal cortex in the left hemisphere. No significant interaction effect of age and diagnostic group on variation in cortical thickness was demonstrated. Among patients, dose or type of antipsychotic medication did not affect variation in cortical thickness. The results from this hitherto largest study on the topic show that prefrontal and temporal cortical thinning in patients with schizophrenia compared to controls is as pronounced in older as in younger subjects. The lack of significant influence from antipsychotic medication supports that regional cortical thinning is an inherent feature of the neurobiological disease process in schizophrenia.
Schizophrenia research, 2009
Brodmann's area (BA) 10, which occupies the frontal pole (FP) of the human brain, has been proven to play a central role in the executive control of cognitive operations. Previous in vivo morphometric studies of the FP have been limited by the lack of an accepted boundary of its posterior limit. We studied the FP gray matter volume in 23 healthy subjects who were age-, sex-, and education-matched to 23 neuroleptic-naïve recent-onset schizophrenia subjects in the age span 20-40 years, using a cytoarchitectonically and functionally valid landmark-based definition of its posterior boundary that we proposed recently (John, J.P., Yashavantha, B.S., Gado, M., Veena, R., Jain, S., Ravishankar, S., Csernansky, J.G., 2007. A proposal for MRI-based parcellation of the frontal pole. Brain Struct. Funct. 212, 245-253. 2007). Additionally, we examined the relationship between FP volume and age in both healthy and schizophrenia subjects to examine evidence for a possible differential relationship between these variables across the samples. A major finding of the study was the absence of a group-level difference in frontal pole gray volumes between the healthy and schizophrenia participants. However, a more complex finding emerged in relation to age effects. The healthy participants showed an inverse relationship of FP gray volume with age, even after taking total brain volume differences into account. But this age effect was completely absent in the schizophrenia group. Moreover, all the volumetric measures in schizophrenia subjects showed substantially higher range, variance, skewness and kurtosis when compared to those of healthy subjects. These findings have implications in understanding the possible role of FP in the pathophysiology of schizophrenia.
PLoS ONE, 2014
Studies show evidence of longitudinal brain volume decreases in schizophrenia. We studied brain volume changes and their relation to symptom severity, level of function, cognition, and antipsychotic medication in participants with schizophrenia and control participants from a general population based birth cohort sample in a relatively long follow-up period of almost a decade. All members of the Northern Finland Birth Cohort 1966 with any psychotic disorder and a random sample not having psychosis were invited for a MRI brain scan, and clinical and cognitive assessment during 1999-2001 at the age of 33-35 years. A follow-up was conducted 9 years later during 2008-2010. Brain scans at both time points were obtained from 33 participants with schizophrenia and 71 control participants. Regression models were used to examine whether brain volume changes predicted clinical and cognitive changes over time, and whether antipsychotic medication predicted brain volume changes. The mean annual whole brain volume reduction was 0.69% in schizophrenia, and 0.49% in controls (p = 0.003, adjusted for gender, educational level, alcohol use and weight gain). The brain volume reduction in schizophrenia patients was found especially in the temporal lobe and periventricular area. Symptom severity, functioning level, and decline in cognition were not associated with brain volume reduction in schizophrenia. The amount of antipsychotic medication (dose years of equivalent to 100 mg daily chlorpromazine) over the follow-up period predicted brain volume loss (p = 0.003 adjusted for symptom level, alcohol use and weight gain). In this population based sample, brain volume reduction continues in schizophrenia patients after the onset of illness, and antipsychotic medications may contribute to these reductions.
Cortical thickness, gray matter volume, and white matter anisotropy and diffusivity in schizophrenia
Neuroradiology, 2011
Introduction The study was conducted to evaluate simultaneously gray matter changes and white matter changes in patients with schizophrenia. Methods Cortical thickness, gray matter volume, and white matter anisotropy and diffusivity changes in schizophrenic patients (n=21) were assessed relative to age-, gender-, and parental socioeconomic status-matched healthy controls (n=21). We used a newly described semi-automated method (FreeSurfer version 4.5) to determine cortical thickness and gray matter volume and used the tract-based spatial statistics method to evaluate white matter anisotropy and diffusivity.
Gray matter deficits in young onset schizophrenia are independent of age of onset
Biological Psychiatry, 1996
This study examined whether the degree of brain dysmorphology observable in adulthood was related to onset age of schizophrenic symptoms. Brain magnetic resonance imaging (MRI) scans were acquired in 57 men with schizophrenia, whose age at MRI was 19-53 years, and whose symptom onset ranged from age 7 to 29 years; all were inpatients in a state hospital Volumes of intracranial space, cortical gray matter (GM) and white matter (WM), and cerebrospinal fluid (CSF) in lateral and third ventricles and cortical sulci were derived from MRI scans and corrected by regression analysis for variations attributable to age and head size, quantified in a control sample of healthy communi~ volunteers. The schizophrenic patients had larger volumes of cortical and ventricular CSF and smaller volumes of cortical GM but not WM than age-matched controls, whether or not volumes were adjusted for head size and age norms. Age of onset did not correlate with any of the five age-adjusted brain measures. Neither current age, length of illness, nor symptom severi~ correlated with age-normalized volumes of cortical GM, sulcal CSF, or ventricular CSF. These observations are consistent with the theory that brain structure deficits' 1) first develop prior to symptom onset (perhaps during the prenatal and~or early childhood process of GM development); 2) probably establish a vulnerability to subsequent dysfunctionality; but 3) are nonprogressive.